THE EVOLUTION OF LATERAL RHACHOTOMY

It is clear that in lateral rhachotomy we have a procedure which is appropriate for approach to the vertebral bodies in a variety of pathological processes including, besides the relief of Pott's paraplegia, the treatment of non-paraplegic tuberculosis, the exploration of spinal tumours, the relief of certain types of traumatic paraplegia and the drainage of suppurative osteitis of the vertebral bodies. For tuberculous disease we find in lateral rhachotomy a technical procedure which provides a meeting point for the solution of several ideas. These are the evacuation of tuberculous abscesses as enunciated by Pott and developed by Ménard, the revascularisation of avascular areas, the removal of necrotic material and the direct removal of the features causing spinal cord compression. It is to the latter only that I think I have made a small contribution. For all other purposes, between lateral rhachotomy and the classical costo-transversectomy, the differences if any are extremely small. The fact remains that the direct surgical approach to lesions of the vertebral bodies has a wide scope of usefulness.